Safety of intranasal corticosteroids in acute rhinosinusitis

Treatment guidelines for acute rhinosinusitis (RS) recommend the use of intranasal corticosteroids (INSs) as monotherapy or adjunctive therapy. However, the adverse event (AE) profiles of oral glucocorticoids, which result largely from the systemic absorption of those agents, have engendered concern...

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Autor principal: Demoly, Pascal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115254/
https://www.ncbi.nlm.nih.gov/pubmed/19144302
http://dx.doi.org/10.1016/j.amjoto.2007.11.004
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author Demoly, Pascal
author_facet Demoly, Pascal
author_sort Demoly, Pascal
collection PubMed
description Treatment guidelines for acute rhinosinusitis (RS) recommend the use of intranasal corticosteroids (INSs) as monotherapy or adjunctive therapy. However, the adverse event (AE) profiles of oral glucocorticoids, which result largely from the systemic absorption of those agents, have engendered concerns about the safety of INSs. These concerns persist for INSs despite significant or marked clinical differences between them and systemic corticosteroids in systemic absorption and among the INSs in bioavailability, mechanism of action, and lipophilicity, which may contribute to differences in AEs. For example, the systemic bioavailability of the INSs as a percentage of the administered drug is less than 0.1% for mometasone furoate, less than 1% for fluticasone propionate, 46% for triamcinolone acetonide, and 44% for beclomethasone dipropionate. A review of the safety profiles of INSs, as reported in clinical trials in acute and chronic RS and allergic rhinitis, shows primarily local AEs (eg, epistaxis and headache) that are generally classified as mild to moderate, with occurrence rates that are similar to those with placebo. Studies of the safety of mometasone furoate, fluticasone propionate, budesonide, and triamcinolone acetonide did not identify any evidence of systemic AEs, such as growth retardation in children due to suppression of the hypothalamic-pituitary-adrenal axis, bone mineral density loss, or cataracts, which suggests that INSs can be safely administered in patients with acute RS without concern for systemic AEs.
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spelling pubmed-71152542020-04-02 Safety of intranasal corticosteroids in acute rhinosinusitis Demoly, Pascal Am J Otolaryngol Current Review Treatment guidelines for acute rhinosinusitis (RS) recommend the use of intranasal corticosteroids (INSs) as monotherapy or adjunctive therapy. However, the adverse event (AE) profiles of oral glucocorticoids, which result largely from the systemic absorption of those agents, have engendered concerns about the safety of INSs. These concerns persist for INSs despite significant or marked clinical differences between them and systemic corticosteroids in systemic absorption and among the INSs in bioavailability, mechanism of action, and lipophilicity, which may contribute to differences in AEs. For example, the systemic bioavailability of the INSs as a percentage of the administered drug is less than 0.1% for mometasone furoate, less than 1% for fluticasone propionate, 46% for triamcinolone acetonide, and 44% for beclomethasone dipropionate. A review of the safety profiles of INSs, as reported in clinical trials in acute and chronic RS and allergic rhinitis, shows primarily local AEs (eg, epistaxis and headache) that are generally classified as mild to moderate, with occurrence rates that are similar to those with placebo. Studies of the safety of mometasone furoate, fluticasone propionate, budesonide, and triamcinolone acetonide did not identify any evidence of systemic AEs, such as growth retardation in children due to suppression of the hypothalamic-pituitary-adrenal axis, bone mineral density loss, or cataracts, which suggests that INSs can be safely administered in patients with acute RS without concern for systemic AEs. Elsevier Inc. 2008 2008-06-16 /pmc/articles/PMC7115254/ /pubmed/19144302 http://dx.doi.org/10.1016/j.amjoto.2007.11.004 Text en Copyright © 2008 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Current Review
Demoly, Pascal
Safety of intranasal corticosteroids in acute rhinosinusitis
title Safety of intranasal corticosteroids in acute rhinosinusitis
title_full Safety of intranasal corticosteroids in acute rhinosinusitis
title_fullStr Safety of intranasal corticosteroids in acute rhinosinusitis
title_full_unstemmed Safety of intranasal corticosteroids in acute rhinosinusitis
title_short Safety of intranasal corticosteroids in acute rhinosinusitis
title_sort safety of intranasal corticosteroids in acute rhinosinusitis
topic Current Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115254/
https://www.ncbi.nlm.nih.gov/pubmed/19144302
http://dx.doi.org/10.1016/j.amjoto.2007.11.004
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